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Anal Fissure

Medically reviewed by Last updated on Mar 5, 2023.

What is an anal fissure?

An anal fissure is a cut or tear in the tissue inside your anus. An anal fissure may be acute or chronic. An acute anal fissure is usually small and shallow and often heals without treatment. A chronic fissure may last longer than a month and will usually require treatment. A chronic anal fissure comes back after treatment.

What causes an anal fissure?

Anal fissures may occur when your anal muscle becomes too tight. Your anal muscle forms a ring around your anus and helps control your bowel movements. When this muscle becomes too tight, there is decreased blood flow to your anus. You may also have too much pressure around your anus. Other possible causes may include any of the following:

  • Bowel problems: Constipation may cause you to strain, which may cause an anal fissure. Certain bowel diseases may also cause anal fissures, including Crohn disease and inflammatory bowel disease.
  • Cancer: Cancer in your anus may cause your anal tissue to tear. Leukemia is another cancer that may cause you to have an anal fissure. Treatments for cancer, such as chemotherapy, may also cause an anal fissure.
  • Infections: Certain infections, such as HIV, syphilis, and tuberculosis may increase your risk for an anal fissure.
  • Trauma: The area around your anus may tear when you give birth. Anal trauma may also be caused by anal intercourse.

What are the signs and symptoms of an anal fissure?

  • Pain that lasts several hours around your anus after you have a bowel movement
  • Bleeding from your anus
  • Bright red blood in your bowel movement or spots of blood on your toilet paper
  • Pain while you urinate or have sex
  • Spasms in your anus
  • Itching around your anus

How is an anal fissure diagnosed?

Your healthcare provider will ask about your symptoms and when they started. Tell your provider about your bowel movements, foods you eat, and medicines you take. Your provider may also ask if you have other medical conditions, or had anal procedures or surgeries. Your provider will look at and feel your anus to check for cuts or tears. If you are in severe pain, you may get local anesthesia. Your provider may also remove a piece of anal tissue and send it to a lab for testing.

How is an anal fissure treated?

You may also need to have the cause of your anal fissure treated. You may need any of the following to treat your anal fissure:

  • Home care:
    • Sitz bath: You may need to soak in a warm tub or take a sitz bath. A sitz bath may decrease your pain and relax your anal muscle. You may need to do this more than once a day. Ask your healthcare provider for information on how to use a sitz bath and how often you should bathe.
    • Nutrition: Eat foods that are high in fiber. This will help keep your bowel movements soft. High-fiber foods include fruits, vegetables, and whole grains.
    • Drink more liquids: Liquids may help soften your bowel movements. This will help prevent you from straining. Ask your healthcare provider how much liquid you should drink each day.
  • Medicine:
    • Stool softeners: Your healthcare provider may also give you medicine that makes your bowel movements softer. This helps prevent constipation. You will be less likely to strain and cause an anal fissure if you are not constipated.
    • Prescription pain medicine may be given. Ask your healthcare provider how to take this medicine safely. Some prescription pain medicines contain acetaminophen. Do not take other medicines that contain acetaminophen without talking to your healthcare provider. Too much acetaminophen may cause liver damage. Prescription pain medicine may cause constipation. Ask your healthcare provider how to prevent or treat constipation.
    • Topical medicine: Topical medicine may be put just inside your anus. The medicine may help your anal muscle relax and increase blood flow to your anus. This medicine may contain anesthesia to help decrease your pain. Your healthcare provider will teach you the right way to use topical medicine.
    • Botulinum toxin: This is medicine given as a shot into the skin around your anus. It helps your anal muscle relax. Ask your healthcare provider for more information about botulinum toxin.
  • Surgery: You may need surgery if other treatments do not work. You may also need surgery if your anal fissure is very painful. Surgery is often used for chronic anal fissures. The most common surgery is called a lateral internal sphincterotomy. A small part of your anal muscle is cut to help relax your anal muscle and decrease your pain. Your healthcare provider may remove all or some of your anal fissure. This is called a fissurectomy.

Treatment options

The following list of medications are in some way related to or used in the treatment of this condition.

What are the risks of an anal fissure?

  • Topical medicine for your anal fissure may give you a headache or make you feel lightheaded. Your skin may become red and you may also have a burning feeling on your anus. The botulinum toxin shot may hurt and may cause muscle weakness. It may also cause a painful infection of the tissue covering your anal muscles. You may also be less able to feel the area in and around your anus. Botulinum toxin or surgery may make you unable to control your bowel movements or passing gas. This is called incontinence. Surgery may also cause bleeding, an infection, or injury to your anal tissue. Even with treatment, your anal fissure may occur again.
  • Without treatment, your anal fissure may deepen or become infected. You may develop an abnormal opening from your anus to nearby organs. Scar tissue may form in your anus and cause it to become narrow. Without treatment, you may have worse pain during bowel movements.

When should I contact my healthcare provider?

  • You are unable to have a bowel movement.
  • You have spasms in your anus that do not stop.

When should I seek immediate care or call 911?

  • You have very bad pain in or around your anus.
  • You have bleeding from your anus that does not stop.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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